Working the Hawaiian night shift

Six years ago I moved to the island of O’ahu to escape Michigan's harsh winters.
I decided to try working nights as a nocturnist hospitalist on a trial basis; I expected
to return to days after one year. Surprisingly my new night schedule was not only
workable, but I preferred it.

On the plus side are incentives such as fewer scheduled hours per month and more flexible
vacation time in comparison to my daytime colleagues—for similar pay. The hospital
where I work is a busy 500-bed Level II trauma center, but there is a certain solitude
at night. You get to do more “pure medicine” and there is not as much
emphasis on social work, case management and family conferences. I see the patient
first on admission and the diagnostic problem solving is very rewarding.

Courtesy of Gurdev Singh.

Moreover, nocturnists attend fewer administrative and committee meetings. And we never
have to wait for an elevator or parking spaces. My schedule consists of 12-hour shifts
for three nights on, and then I have five days off to relax and recover. I like the
lifestyle. My wife and I still breakfast together when I get home, before she heads
off to work. Paradoxically, although we work opposite shifts, we now have more free
time together, which we spend exploring Hawaii's beautiful beaches and mountain trails.

But nights are not for everyone. One downside is that the day hospitalists are the
ones to have the satisfaction of seeing the very sick patients get better and leave
the hospital. There is also an extended adjustment period as one's body adapts to
changes in sleep and work patterns. I work with several dedicated nocturnists, and
all of us handle sleep transitions in entirely different ways. Consequently we are
extremely sensitive to changes in our work schedules. My program director put it this
way: “You think day people schedules are tricky? Try tweaking the nights.”

I find that after a particularly busy series of shifts, sleep debt can take two days
to pay off. Working more than three nights in a row triggers problems with transitioning
back to days and can cause headaches and a lack of focus. Impediments to sleep include
normal everyday activities that day-working people don't think about, like daylight
and the din of lawn mowers, leaf blowers and barking dogs. Many of us night-workers
rely on blackout curtains, white noise and occasionally sleep aids such as melatonin
or a benzodiazepine. There is also a body of research about the health risks associated
with night work, including depressed immune systems, injury, breast and prostate cancer,
metabolic syndrome, impaired coronary circulation, diabetes and obesity, syncope and
obstructive sleep apnea.

Managing the transition between day and night is a science and an art. It is worthwhile
to review the literature on night and shift work and consider what works for you,
and how your family and loved ones feel about it. Each individual has to create his
or her own balance, which is an ongoing process. Ultimately it is the unique blend
of professional, environmental and personal factors that will determine if nights
are a good option for you, as they are for me.

ACP Hospitalist provides news and information for hospitalists, covering the major issues in the field. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated.